Spatial and Temporal Analysis of Hospitalizations Due to Primary Care-Sensitive Conditions Related to Diabetes Mellitus in a State in the Northeast of Brazil.

Abstract

Hospitalizations due to primary care-sensitive conditions (PCSCs) can be considered a proxy for the effectiveness of primary healthcare (PHC), especially diabetes mellitus (DM). The aim of this study was to analyze the temporal, spatial, and space-time patterns of PCSCs associated with DM in a state in Northeast Brazil from 2008 to 2022. An ecological and time-series study that included all records related to PCSCs-DM from the 75 municipalities of Sergipe was conducted. Segmented linear regression, global (I) and local (LISA) Moran indices, spatial scanning, Spearman correlation tests, bivariate I, and LISA were used in our analysis to examine the temporal trends and clusters of high spatial risk. Overall, 14,390 PCSCs-DM were recorded between 2008 and 2022. There was a higher prevalence of PCSCs-DM among women (53.75%) and individuals over 70 years old (57.60%). Temporal trends in PCSCs-DM were increasing with regard to the overall rate (AAPC: 2.39); males (AAPC: 3.15); age groups ≤ 19 years (AAPC: 6.13), 20-39 years (AAPC: 4.50), and 40-59 years (AAPC: 2.56); and 3 out of the 7 health regions. There was a positive spatial correlation between per capita income (I = -0.23; p = 0.004) and diabetic foot examination being performed by a nurse in a PHC (I = -0.18; p = 0.019) setting. The heterogeneous spatial distribution of DM hospitalizations demonstrated that this condition is a persistent public health problem in Sergipe.